Rough COVID vaccine rollout in Florida raises questions about second dose

Cindy Krischer Goodman, South Florida Sun Sentinel

The busy signals, crashed websites and vaccine shortages in Florida this week raise concerns about the next step in the COVID vaccination process: The second dose.

Both vaccines approved for use in the United States require two injections, the Pfizer vaccine after three weeks, the Moderna vaccine after four weeks. With the first doses administered in Florida on Dec. 14, that means second doses will be required starting next week.

Some hospitals are holding back vaccines because they want to be sure they’ll have enough to administer second doses, said Jared Moskowitz, director of Florida’s Division of Emergency Management. Although Moskowitz shares their concern, he said they could face penalties for holding back lifesaving medicine. He did not name the hospitals.

“We have told everybody that is not acceptable,” he said. “It doesn’t help save a life sitting in the freezer. No one has more anxiety about the second doses arriving than myself, but it is not up to the providers to hold back vaccines.”

Florida has administered only a fraction of the doses received so far. As of Wednesday, Florida had received 783,600 doses, according to the U.S. Centers for Disease Control. A total of 211,165 first doses have been administered in the state, according to a report issued Thursday by the Florida Department of Health. No second doses have been given yet.

Memorial Healthcare System, which serves southern Broward County, received 19,500 doses from Pfizer Thursday morning to give to healthcare workers for their second dose. The hospital system, which began giving inoculations Dec. 14, will start administering the second injections next week.

“We did not hold doses behind, because the state had committed to give us more,” said Dorinda Segovia, vice president of pharmacy for Memorial Healthcare System.

“We have a lot of people scheduled for the second dose,” she said, and Pfizer has “delivered as promised.”

Segovia said everyone inoculated in the first group has been getting reminders. The ideal window for the second shot is 19 to 23 days, she said. “We don’t have too many people who are pending scheduling their second dose.”

Concern about the second dose is one reason only a fraction of the doses received by the state has been administered, Moskowitz said. There’s concern about the continuity of the federal supply of vaccines, he said.

“The federal government did not do a good job providing the forward-looking distribution plan,” he said. “It’s a week-to-week plan. It’s hard for hospitals, who have a lot of anxiety about distributing the vaccine because they want to make sure they have enough vaccine for the second shot. I don’t think we have been provided a lot of insight into when we are getting the second dose. I think those two things combined is what has led a lot of providers to sitting on vaccine.”

But he said they don’t have that option.

“The instruction we have been given by CDC, HHS, Operation Warp Speed — for everyone receiving the first dose, the second dose is coming,” he said.

But nationally there’s also concern that not enough first doses have been given out.

Dr. Anthony Fauci, the top federal infectious disease official, said the “disappointing” results of the first round of vaccinations may lead the government to distribute vaccines more widely and hold back less for second doses.

With fewer than 3 million people vaccinated, the country fell far short of its target of vaccinating 20 million people by the end of the year.

“There is a lot of discussion about whether or not you want to spread out the initial vaccination by getting more people vaccinated on the first round,” Fauci said on NBC’s Today Show.

The second dose doesn’t need to be administered exactly three or four weeks later. No one would have to start the series all over because they failed to get the second one on time. But it is necessary to confer the maximum amount of protection.

The two-dose issue may be less of a concern in the future. Other vaccines in the pipeline, such as Johnson & Johnson’s, require only a single dose.

The Florida Department of Health in Broward County announced three sites at public parks where it will begin giving vaccines next week. Some residents were able to get appointments before the health department’s website crashed on Wednesday. On Thursday, a spokesperson said, “those who get vaccinated will get a return date of three weeks later when they get their first dose.”

At Jackson Health System, the nonprofit hospital system in Miami-Dade County, vaccinations are planned to be administered next week at a rate of more than 1,000 a day. The hospital system issued the first shots to employees Dec. 15, and there is no concern that second doses will not be available, spokeswoman Tania Leets said.

“Those who already received the first shot have been guaranteed by the state and others that we will have ample supply to provide the second shot on schedule, beginning next Monday,” she said. “There are no concerns in administering the second dose.”

Dr. Alina Alonso, director of the Florida Department of Health Palm Beach, said the second-dose logistics will be challenging.

“For every vaccine that is given out, that date four weeks later will be tied up with the same volume of people,” she said. “And that’s tricky and complicated.”

Her agency is working on a computer system that will automatically set an appointment for the second dose four weeks after the administration of the first.

“Do not panic,” Alonso said. “We don’t want to see senior citizens in wheelchairs or walkers in line in the heat waiting for hours. We do not want that. There will be plenty of appointments. We will have multiple sites, multiple partners and they will all have plenty of vaccine.”

David Fleshler can be reached at dfleshler@sun-sentinel.com or 954-356-4535. Health reporter Cindy Goodman can be reached at cgoodman@sunsentinel.com